Family Rejection, Socioeconomic Precarity, and Exchanging Sex for Food among Young Transgender Adults: Findings from the U.S. Transgender Survey.

This study explored factors associated with elevated risk of exchanging sex for food in young transgender adults in the U.S. We analyzed data from a sample of trans-gender adults (18-35 years old) who participated in the 2015 U.S. Transgender Survey. Participants were asked if they had engaged in sexual activity for food within the past year or more than a year ago. Welfare participation, family rejection, and experience of homelessness were significantly associated with a higher likelihood of exchanging sex for food. Young transgender adults with multiple marginalized identities, such as identifying as Black or African American, presenting a non-normative gender expression, and living with a disability, were at higher risk of engaging in sex for food. Our study underscores family rejection and socioeconomic precarity, which may erode the social support and safety net of young transgender adults, preventing them from affording and accessing adequate food.

Frontline, Essential, and Invisible: The Needs of Low-Wage Workers in Hospital Settings During COVID-19.

BACKGROUND: Frontline health care workers are particularly vulnerable to burnout and diminished well-being as they endure COVID-19 pandemic-related stressors. While physicians and nurses are the public face of those experiencing burnout in hospitals, these stressors also affect low-wage workers such as food and housekeeping/janitorial service workers whose roles largely remain "invisible" when conceptualizing the essential health workforce and understanding their needs. This study sought to understand the experiences of frontline essential workers to better support them and prevent burnout. METHODS: Using a semi-structured interview guide, we conducted 20 in-depth qualitative interviews with workers in three U.S. states. Thematic content analysis was conducted to code and analyze interviews. RESULTS: Workers had an average of 5.8 years in their jobs, which included food services, housekeeping/janitorial, and patient transport roles. Analysis revealed four prominent stressors contributing to worker burnout: changes in duties and staff shortages, fear of contracting or transmitting COVID-19, desire for recognition of their job-related risk, and unclear communication on safety precautions and resources. Protective factors included paid time-off, mental health supports, sense of workplace pride, and self-coping strategies. CONCLUSION/APPLICATION TO PRACTICE: As health systems continue to grapple with care delivery in the context of COVID-19, identifying best practices to support all workers and prevent burnout is vital to the functioning and safety of hospitals. Further consideration is warranted to create policies and multipronged interventions to meet workers' tangible needs while shifting the culture, so all members of the health workforce are seen and valued.

What Do EHRs Tell Us about How We Deploy Health Professionals to Address the Social Determinants of Health.

The objective of this study was to determine how well Electronic Health Record (EHR) documentation identifies which health professionals act to address patient social determinants of health (SDOH) and what interventions are documented. The Electronic Medical Record Search Engine was used to identify food and housing insecurity EHR notes. From the notes, researchers randomly sampled 60 from each SDOH category. Of 120 notes, which contained a reference to food or housing insecurity, 72% also contained information on an intervention taken. Interventions were documented by social workers 63% of the time, followed by dietitians and physicians. Addressing patient SDOH is a crucial part of comprehensive healthcare. Findings contribute to a broader conversation on the documentation and interventions in healthcare settings to address patients' SDOH. Findings support the critical importance of standardizing SDOH documentation in the EHR across more members of the health workforce to ensure patient needs are met.